ArticleEmergency medicine journal : EMJ2023
Prevalence of secondary insults and outcomes of patients with traumatic brain injury intubated in the prehospital setting: a retrospective cohort study.
Article in Emergency medicine journal : EMJ, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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8 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Safer prehospital anaesthesia: updated guidelines from the Association of Anaesthetists.Anaesthesia · 2026Guideline
- Risk Factor Analysis and Prognosis of Dysphagia in Craniocerebral Injury Patients: Implications for Targeted Nursing Strategies.Brain and behavior · 2026Article
- Lead times in the early management of traumatic brain injury: relation to geographic conditions and clinical outcomes in a nationwide Swedish registry study.Acta neurochirurgica · 2026Observational
- Association of Cerebral Oxygenation During Prehospital Anaesthesia and Functional Outcome: A Prospective, Observational Multi-Centre Cohort Study of 1014 Patients.Acta anaesthesiologica Scandinavica · 2026Observational
- Impact of Prehospital Blood Pressure Profile on Functional Outcome After Traumatic Brain Injury.Journal of clinical medicine · 2025Article
- First Breath Matters: Out-of-Hospital Mechanical Ventilation in Patients with Traumatic Brain Injury.Journal of clinical medicine · 2025Review
- Differences in Eotaxin Serum Levels between Polytraumatized Patients with and without Concomitant Traumatic Brain Injury-A Matched Pair Analysis.Journal of clinical medicine · 2024Article
- Innovative Insights into Traumatic Brain Injuries: Biomarkers and New Pharmacological Targets.International journal of molecular sciences · 2024Review
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrehospital neuroprotective strategies aim to prevent secondary insults (SIs) in traumatic brain injury (TBI). This includes haemodynamic optimisation in addition to oxygenation and ventilation targets achieved through rapid sequence intubation (RSI).The primary aim was to report the incidence and prevalence of SIs (prolonged hypotension, prolonged hypoxia and hyperventilation) and outcomes of patients with TBI who were intubated in the prehospital setting.
methodsA retrospective cohort study of adult patients with TBI who underwent RSI by a metropolitan road-based service in South-East Queensland, Australia between 1 January 2017 and 31 December 2020. Patients were divided into two cohorts based on the presence or absence of any SI sustained. Prolonged SIs were defined as occurring for ≥5 min. The association between SIs and mortality was examined in multivariable logistic regression and reported with adjusted ORs (aORs) and 95% CIs.
results277 patients were included for analysis. Median 'Head' Abbreviated Injury Scale and Injury Severity Score were 4 (IQR: 3-5) and 26 (IQR: 17-34), respectively. Most episodes of prolonged hypotension and prolonged hypoxia were detected with the first patient contact on scene. Overall, 28-day mortality was 26%. Patients who sustained any SI had a higher mortality than those sustaining no SI (34.9% vs 14.7%, p<0.001). Prolonged hypoxia was an independent predictor of mortality (aOR 4.86 (95% CI 1.65 to 15.61)) but not prolonged hypotension (aOR 1.45 (95% CI 0.5 to 4.25)) or an end-tidal carbon dioxide <30 mm Hg on hospital arrival (aOR 1.28 (95% CI 0.5 to 3.21)).
conclusionSIs were common in the early phase of prehospital care. The association of prolonged hypoxia and mortality in TBI is potentially more significant than previously recognised, and if corrected early, may improve outcomes. There may be a greater role for bystander intervention in prevention of early hypoxic insult in TBI.
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